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OPINION

How long should Iowans wait for a call button response?

Iowa is one of the few states to have a required response time for nursing home call buttons, but many Iowans will be surprised to learn how long staff are allowed to take.(Photo: Rufous52, Getty Images/iStockphoto)

Imagine a loved one is a resident of a nursing home. He or she is in bed, needs help and presses the call button. How long do you think it should take someone to respond?

Think about that. What would be acceptable to you? To them?

As part of my research on response times, I’ve asked the question above to at least 200 Iowans. The overwhelming response? No more than three to five minutes. I’ve yet to hear someone say it would be OK if it took longer than five minutes.

Many people are surprised to learn that the state of Iowa, through a rule of the Department of Inspections and Appeals, defines an acceptable time frame for response.

Before revealing the rule, what’s been your experience with call light response?

Have caring and competent direct care staff responded quickly and dealt with the situation? Or did you and your loved one have to wait, and wait — until an overworked staff member could get to you?

My family and I have experienced both — too often the delayed response. I’ve talked with dozens of dozens of other families who’ve dealt with the same.

The consequences of delayed response can be adverse if not tragic.

Residents can suffer extended pain or discomfort. They can become anxious, agitated or violent. They can experience the humiliation of soiling themselves, or having their medical condition worsen, resulting in a trip to the emergency room — with unknown and often unpleasant outcomes.

Bottom line: Delayed care is denied care.

So back to Iowa’s policy.

The state’s rule says that an acceptable response time to a call for help from a nursing home resident is anything up to 15 minutes.

Fifteen minutes.

When I tell people that, jaws drop. The typical response is something like, “Fifteen minutes? You’ve got to be kidding me!”

The only Iowans that I’ve found who see the rule as acceptable are at the Department of Inspections and Appeals.

I know because I asked; the first time was more than two years ago. The most recent time was two weeks ago.

I asked department officials to replace the standard with something that reflected what any Iowan would want and deserve. I reminded them that this was a policy created years ago by the department, and could be changed by the department.

Officials responded with a one line email message: “Iowa has a 15-minute rule and we see no reason to change it.”

When pressed for details, the department told me that most other states have no standard, and nursing homes would be challenged to meet a revised and better standard.

My response: Does it matter what standards other states have? Does it matter whether nursing facilities would be challenged in meeting an expectation for better service? Shouldn’t our focus be on what’s right for residents?

The department also said it could just eliminate the standard altogether.

I said that I didn’t think this should be a choice between a bad standard and no standard. I suggested a third choice: to create a new, reasonable and effective standard.

But let’s look at the real issue here. It’s not call buttons. It’s about the amount of staff nursing homes have on duty to respond to call buttons.

Too many nursing homes operate with too little staff. They aren’t finding and keeping the front-line, direct care staff needed. As a result, the staff on duty can’t adequately respond to call buttons.

I suggest we change the 15-minute rule to what Iowans want and expect, and let’s verify that by doing something unique for government — let’s ask the customer: the people in the beds, their family members and the Iowa taxpayer! What would your suggestion be?

The process of revising the rule could be the catalyst needed to address chronic staff shortages, improve call button response and enhance overall service to Iowans.

Let’s get the Office of the Long-Term Care Ombudsman, the Department of Inspections and Appeals, the nursing home industry, consumers, workers and their advocates, and others to sit down to come up with solutions.

John Hale(Photo: Special to the Register)

I am pressing the call button. What will the response be?

JOHN HALE is a 60-something upstart who is a contributor to A Better Iowa. He owns The Hale Group, a consulting and advocacy firm that provokes thought and action on aging and caregiving issues. Contact: hale_johnd@msn.com